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1205818275

NPI Code Detail

MEDICARE: JANE A EHNSTROM CCC A

MEDICARE: JANE A EHNSTROM CCC A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	324	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AA3440	OTHER		HARVARD PILGRIM HEALTHCAR
2	AD0171	OTHER		BLUE SHIELD IDEMNITY
3	042472266	OTHER		THREE RIVERS
4	7941616	OTHER		AETNA US HEALTHCARE
5	AD0171	OTHER		BLUE SHIELD HMO BLUE
6	042472266039	OTHER		TRICARE CHAMPUS
7	AD0171	OTHER		BLUE CARE ELECT
8	54936	OTHER		FALLON COMMUNITY HEALTH P
9	042472266	OTHER		ONE HEALTH PLAN
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	042472266	OTHER		UNITED HEALTHCARE

General Provider Information

NPI Number	:	1205818275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE A EHNSTROM CCC A

Provider Business Mailing Address
First Line	:	48 ELM ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01609-2541
Country	:	US
Telephone Number	:	508-757-0330
Fax Number	:	508-754-9426

Provider Business Practice Location Address
First Line	:	48 ELM ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01609-2541
Country	:	US
Telephone Number	:	508-757-0330
Fax Number	:	508-754-9426

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	08/25/2009

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Directions to “ JANE A EHNSTROM CCC A” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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